Harman Halil, Tekeoğlu İbrahim
Department of Pysical Medicine and Rehabilitation, Rheumatology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
Int J Rheum Dis. 2017 Jun;20(6):675-684. doi: 10.1111/1756-185X.13007. Epub 2017 Mar 12.
We determined ankle pathologies in patients with different types of inflammatory rheumatic diseases using high-resolution ultrasonographic (US) images, and compared the findings among the different patient groups.
The study included 142 randomly selected inflammatory rheumatic disease patients with clinically swollen or painful ankle joints; 69 patients had rheumatoid arthritis (RA), 58 had spondyloarthropathies (SpA) and 15 had gout. Ankle assessment on US included all of the important anatomical structures. The foot function of patients was evaluated using the Foot Function Index (FFI).
Among all the patients, 98.6% of joints were tender and 72.9% were swollen; 82.1% joints were pathological on US. Tibiotalar joint synovitis was observed significantly more frequently in the SpA and gout patients (P < 0.05). Tibialis posterior (TP) tenosynovitis was significantly more common in the RA group than in the other groups (P < 0.001). Subtalar and talonavicular joint synovitis were observed more frequently in the early RA group compared to the other groups (P < 0.05). Tibiotalar joint synovitis was observed more frequently > 1 year after RA diagnosis (P < 0.05). Subtalar joint synovitis, TP tenosynovitis, and peroneus tenosynovitis were the best predictors of higher FFI scores in patients with RA (R c = 0.360, F = 11.83, P < 0.000).
Tendon involvement in our RA patients was observed more frequently than has been previously estimated. TP tenosynovitis appears to be more specific for RA, while Achilles tendinitis is more frequent in axial SpA and reactive arthritis. Tibiotalar joint involvement exhibits a time-dependent significant increase in frequency in patients with RA.
我们使用高分辨率超声（US）图像确定不同类型炎性风湿性疾病患者的踝关节病变，并比较不同患者组之间的结果。
该研究纳入了142例随机选择的炎性风湿性疾病患者，这些患者临床上踝关节肿胀或疼痛；69例患有类风湿关节炎（RA），58例患有脊柱关节炎（SpA），15例患有痛风。超声对踝关节的评估包括所有重要的解剖结构。使用足部功能指数（FFI）评估患者的足部功能。
在所有患者中，98.6%的关节有压痛，72.9%的关节肿胀；82.1%的关节在超声检查中显示病变。在SpA和痛风患者中，胫距关节滑膜炎的观察频率明显更高（P < 0.05）。胫后肌腱腱鞘炎在RA组中比其他组明显更常见（P < 0.001）。与其他组相比，早期RA组距下和距舟关节滑膜炎的观察频率更高（P < 0.05）。在RA诊断后>1年观察到胫距关节滑膜炎的频率更高（P < 0.05）。距下关节滑膜炎、胫后肌腱腱鞘炎和腓骨肌腱腱鞘炎是RA患者FFI评分较高的最佳预测指标（R c = 0.360，F = 11.83，P < 0.000）。
我们观察到RA患者肌腱受累的频率比先前估计的更高。胫后肌腱腱鞘炎似乎对RA更具特异性，而跟腱炎在轴性SpA和反应性关节炎中更常见。RA患者胫距关节受累的频率随时间呈显著增加。
